Type A aortic dissection involving the carotid arteries: carotid stenting during open aortic arch surgery.
Aortic dissection involving the arch can be complicated by extension to the supra-aortic branches. Carotid dissection may be symptomatic or asymptomatic at the time of surgery. Dissection or re-dissection of repaired carotid may happen later, with symptoms occurring days after the surgical repair, increasing the morbidity and mortality of those patients. We report a case of a patient with type A aortic dissection involving the aortic arch and extending to the supra-aortic branches. During surgery the dissection was seen extending to the distal carotid arteries with tears in the inner wall. After use of surgical glue as a sealant, seeing the persistent fragility and the presence of spiral form tears in the internal wall of the carotid arteries, intraoperative stenting of the common carotid arteries was performed using two stents to prevent carotid re-dissection and ischemic stroke in the postoperative period. In patients with aortic dissection and extension into the carotid arteries, especially with presence of tears of the inner wall, after use of a glue as a sealant of the two dissected layers, if the repaired artery wall results are still fragile, use of intraoperative carotid stenting may be of help in preventing late re-dissection.
Lentini
Salvatore
S
Department of Cardiac and Vascular Surgery, University Hospital, University of Messina, Messina, Italy. salvolentini@alice.it
Tancredi
Fabrizio
F
Benedetto
Filippo
F
Gaeta
Roberto
R
D000784:Aortic Dissection / Q000150:complications / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D020215:Carotid Artery, Internal, Dissection / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004338:Drug Combinations; D005557:Formaldehyde / Q000627:therapeutic use; D005780:Gelatin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012118:Resorcinols / Q000627:therapeutic use; D015607:Stents; D014014:Tissue Adhesives / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
D004338:Drug Combinations; D012118:Resorcinols; D014014:Tissue Adhesives; C027813:gelatin-resorcinol-formaldehyde tissue adhesive; D005557:Formaldehyde; D005780:Gelatin